MATERNAL and INFANT NUTRITION

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MATERNAL and INFANT NUTRITION

• Stages of Fetal Development
• A newly fertilized ovum (zygote) begins as a
  single cell, and divides to become many cells
  during the days after fertilization
• Within 2 weeks, the zygote embeds itself into the
  uterine wall (implantation)

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Stages of Fetal Development

• After implantation, the placenta develops and
  begins to provide nourishment to the developing
  embryo
• The placenta develops inside the uterus, and it
  provides nutrients and oxygen, as well as a way
  for the developing embryo to return carbon
  dioxide and other wastes to be excreted
• An embryo at 5 weeks after fertilization is ½
  an inch long

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Stages of Fetal Development

• At 8 weeks, the 1¼ inch long embryo has a
  complete nervous system, a beating heart, a
  digestive system, well-defined fingers, and toes,
  and the beginnings of facial features
• The fetus continues to grow during the next 7
  months
• Fetal growth is phenomenal weight increase from
  less than an ounce to 7.5 pounds

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Critical Periods

• Times of intense development and rapid cell
  division are called critical periods (cellular
  activities can only occur at these times)
• Each tissue and organ is most vulnerable to
  adverse influences during its own critical period
  
• Adverse influences include nutrient deficiencies
  or toxins
• An adverse influence felt early irreversibly
  impairs development
• An adverse influence felt late may only
  temporarily impair development

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Critical Periods

• Critical period for neural tube development is 17
  to 30 days gestation folate supplementation
  reduces the risk for neural tube defects
• The brain and spinal cord develop from the neural
  tube, and defects in its orderly formation during
  the early weeks of pregnancy may result in
  various central nervous system disorders (spina
  bifida)

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Critical Periods

• Maternal anemia during the critical period of
  placental growth alters the pattern of blood
  vessel growth, which may affect the
  cardiovascular health of the infant
• Malnutrition during the critical period of
  pancreatic cell growth may contribute to the
  development of diabetes in adulthood

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MATERNAL WEIGHT

• A womans weight prior to conception influences
  fetal growth
• Underweight higher risk of a LBW infant, higher
  risk of a preterm infant
• Overweight higher risk of medical complications
  such as hypertension, gestational diabetes, and
  postpartum infections. Also since the baby may
  be larger then normal - may lead to difficult
  labor, delivery, and birth trauma
• However, weight loss during pregnancy is NEVER
  advisable

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Weight Gain During Pregnancy

• All pregnant women must gain weight fetal
  growth depends on it
• Maternal weight gain during pregnancy correlates
  closely with infant birthweight, which is a
  strong predictor of the health of the infant

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Weight Gain During Pregnancy
Prepregnancy Weight Status Recommended Weight Gain
Underweight (BMIlt19.8) 28 to 40 pounds
Normal Weight (BMI 19.0-26) 25 to 35 pounds
Overweight (BMI 26-29) 15 to 25 pounds
Obese (BMI gt29) 15 pounds minimum
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Weight Gain Patterns

• Normal weight women should gain 3 lbs. in the
  first trimester, and just under 1 lb/week
  thereafter
• Underweight women 1st trimester 5 lbs., 1
  lb/week thereafter
• Overweight women 1st trimester 2 lbs., 2/3
  lb/week thereafter

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Components of Weight Gain

• Most of the weight gain supports the growth and
  development of the placenta, uterus, blood, and
  breasts, as well as an optimally healthy infant
• A small amount goes into maternal fat stores, and
  that fat has a special purpose to provide energy
  for labor and lactation

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Weight Loss After Pregnancy

• The pregnant women loses some weight at delivery
• In the following weeks, she loses more as her
  blood volume returns to normal and she sheds
  accumulated fluids
• The typical women does not return to prepregnancy
  weight, most tend to retain a couple of pounds
  with each pregnancy
• In general, the more weight a women gains beyond
  the needs of pregnancy, the more she will retain

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Nutrition During Pregnancy

• From conception to birth, all parts of the infant
  bones, muscles, organs, skin, and other tissues
  are made from the nutrients in the food that
  mother eats
• ENERGY extra 340 calories in the 2nd and extra
  450 calories in the 3rd trimester
• PROTEIN 25 grams per day higher than the RDA
  (most are already getting that)

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Nutrition During Pregnancy

• ESSENTIAL FATTY ACIDS the brain is largely made
  up of lipid material, and it depends highly on
  the omega 3 and omega 6 fatty acids for its
  growth, function, and structure
• Pregnant women are advised to include seafood,
  leafy greens, nuts, and seeds in their diet

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Mercury in Fish

• FDA has issued an advisory to all pregnant women,
  women who may become pregnant, lactating mothers,
  and young children avoid eating large amounts
  of mackerel, swordfish, shark, tuna, and tilefish
• Pregnant and lactating women one can of tuna
  per week
• Young children less than a can per month
• http//www.doh.wa.gov/fish/FishAdvWomen.htm

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Nutrition During Pregnancy

• Nutrients for
• Blood production and cell growth folate, B12,
  iron, and zinc
• Bone development vitamin D, calcium,
  phosphorus, magnesium, and fluoride

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Supplementation

• Women who make wise food choices during pregnancy
  can meet most of their nutrient needs, however,
  iron and folate are two nutrients that may need
  to be supplemented
• Women of childbearing age who are capable of
  becoming pregnant are advised to consume 400
  micrograms of folate per day (supplements are
  convenient, better absorbed)
• Iron supplements are recommended during the 2nd
  and 3rd trimesters of pregnancy (30 mg per day)

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Nutrition-Related Concerns

• Nausea hormonal changes appear to be
  responsible for a womans sensitivities to the
  appearance, smell, or taste of foods
• Suggestions
• On waking, arise slowly
• Eat small, frequent meals
• Avoid foods with offensive odors
• When nauseated do not drink citrus juice, milk,
  coffee, or tea

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Nutrition-Related Concerns

• Constipation as the hormones of pregnancy alter
  muscle tone and the growing fetus crowds the
  intestinal organs
• Suggestions
• Eat foods high in fiber
• Exercise regularly
• Drink plenty of fluids

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Nutrition-Related Concerns

• Heartburn the hormones relax the digestive
  muscles, and the growing fetus puts increased
  pressure on the mothers stomach
• Suggestions
• Relax and eat slowly
• Chew food thoroughly
• Eat small, frequent meals
• Avoid spicy or greasy foods
• Sit up while eating, elevate head when sleeping
• Wait an hour after eating before lying down

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Gestational Diabetes

• A condition of abnormal glucose tolerance,
  usually during the second half of pregnancy,
  which resolves after birth
• Consequences of GD complications during
  delivery, high infant birthweight, and birth
  defects (heart damage, limb deformities, and
  neural tube defects)
• Risk Factors age, obesity, family history,
  history of abnormal glucose tolerance, ethnicity
  associated with a high incidence of diabetes

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Practices Incompatible with Pregnancy

• Alcohol limits oxygen delivery, slows cell
  division
• Medicinal and illicit drugs
• Tobacco linked to premature labor, breathing
  problems, and fatal illness among infants
• Environmental contaminants
• Vitamin-Mineral megadoses
• Caffeine
• Weight-loss dieting

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Low Birthweight

• Low birthweight (less than 5.5 lbs. or 2500
  grams) is the factor most associated with infant
  mortality.
• Babies who are low birthweight are 40 times more
  likely to die in their first year than healthy
  babies.
• Those who survive are more vulnerable to serious
  health and developmental problems, such as
  blindness, deafness, mental retardation and
  learning disabilities.

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Causes of Low Birthweight Infants

• Poor nutrition
• Genetics
• Disease conditions
• Smoking
• Drug use (including alcohol)

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LACTATION

• Lactation is an automatic process that virtually
  all mothers are capable of doing
• Breastfeeding is a learned behavior

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• The United States Lags in Breastfeeding
• The United States has one of the lowest rates of
  breastfeeding in the industrialized world, and
  one of the highest rates of infant mortality
• Data from 1998 indicate that only 64 percent of
  U.S. mothers initiate breastfeeding, and only 29
  percent report feeding any human milk to their
  infants at six months.
• Those numbers stand in marked contrast to Sweden,
  for example, where the breastfeeding initiation
  rate exceeds 98 percent and the rate at six
  months is 80 percent.

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• What are the barriers to breastfeeding in the US?

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BENEFITS of BREASTFEEDING

• For Infants
• Provides the perfect balance of nutrients with
  high bioavailability
• Provides hormones that promote physiological
  development
• Improves cognitive development
• Protects against a variety of infections
• May protect against some chronic diseases (IDDM,
  hypertension)
• Protects against food allergies

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BENEFITS of BREASTFEEDING

• For Mothers
• Contracts the uterus
• Delays the return of regular ovulation
• Conserves iron stores (by prolonging amenorrhea)
• May protect against breast cancer
• May help the mother to lose weight gained during
  pregnancy (650 cal/day)
• Its cheap! (A nursing mother produces over 35
  gallons of milk during the first six months,
  saving 450 in formula costs)

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Composition of Breast Milk
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Composition of Breast Milk

• Lipids triglycerides are the major energy
  source, also rich in cholesterol, EFAs(EPA, and
  DHA)
• Carbohydrates lactose is the major CHO
• Proteins Whey proteins predominate, all
  essential amino acids, lactoferrin (protects
  infants from infection), other immunoglobulins
  (antibodies)

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Composition of Breast Milk

• Vitamins and Minerals a perfect balance of all
  essential vitamins and minerals
• Other digestive enzymes, anti-infective factors,
  hormones, and growth factors

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Nutrient Needs During Lactation

• Energy RDA during lactation extra 500 kcal/day
  (1800 kcal/day minimum)
• Protein RDA during lactation same as during
  pregnancy
• Vitamins and Minerals milk quality is
  maintained at the expense of the maternal stores
• Nutrients in breast milk most likely to decline
  in response to inadequate stores are B6, B12,
  Vitamin A and D
• In general, nutritional inadequacies reduce the
  quantity, not the quality of breast milk

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High Protein Diets

• There are some concerns that it is not safe for a
  breastfeeding mother to be in ketosis
• The Atkins Center websites recommends that
  pregnant and breastfeeding women adjust their
  carbohydrate intake to maintenance level (enough
  carbohydrate to decrease ketone production)

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Nutrition During Infancy

• Solid foods are introduced based on an infants
  physiological needs, such as depletion of iron
  stores, and on physical development, such as the
  ability to sit up
• Current recommendation 4 to 6 months

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Foods To Omit

• Concentrated sweets
• Canned vegetables
• Honey and corn syrup
• Popcorn, whole grapes, whole beans, hot dog
  slices, hard candies, and nuts
• Cows milk (before 12 months)

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Food Allergies

• Experts recommend introducing single-ingredient
  foods, one at a time, in small portions, and
  waiting 4 to 5 days to introduce the next food
  (rice cereal - barley - oats - wheat)
• A true food allergy occurs when protein fractions
  of a food are absorbed into the blood and elicit
  an immunological response (antibodies,
  histamines, or other defensive agents)
• Food intolerances involve symptoms, but no
  antibodies

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Iron Deficiency

• Iron deficiency has a well-known and wide spread
  effect on childrens behavior
• Symptoms include decreased energy, learning
  ability, attention span, and depressed mood
• The long-term damaging effects of iron deficiency
  make its prevention a high priority

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Nutrition During Infancy

• The two dietary practices that have the most
  effect on an infants nutrition status are the
  milk the infant receives and the age at which
  solid foods are introduced
• Breast feeding is recommended for at least 6
  months, but even 2 to 3 months can give the
  infant immunological protection
• Breast milk is the prefect infant food, but iron,
  Vitamin D, fluoride, and Vitamin K may need to be
  supplemented

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Lead Toxicity

• Children who are malnourished are vulnerable to
  lead poisoning (they absorb more lead if their
  stomachs are empty, and if they have iron
  deficiencies)
• Lead toxicity is most prevalent in children under
  6, and 10-15 of all preschoolers may have blood
  lead concentrations high enough to cause mental,
  behavioral, and other health problems

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Lead Toxicity

• Lead is present in old homes (plumbing), old
  paint, and in some soil
• Children can ingest lead by drinking contaminated
  water, eating paint chips, playing in and around
  lead contaminated house dust or soil
• Lead is not easily excreted and accumulates in
  the bones, brain, teeth, and kidneys
• Deficits in intellectual development are only
  partially reversed when lead levels decline

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Prevalence of Eating Disorders

• More than 5 million Americans suffer from eating
  disorders
• 90 of cases of anorexia and bulimia occur in
  females
• 15 of young women have substantially disordered
  eating attitudes or behaviors
• 8 of overweight women and 30 of those seeking
  treatment from weight loss programs meet criteria
  for binge eating disorder 25 of binge eaters
  may be male

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What Causes Eating Disorders?
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Nutrition-Related Concerns

• Nausea hormonal changes appear to be
  responsible for a womans sensitivities to the
  appearance, smell, or taste of foods
• Suggestions
• On waking, arise slowly
• Eat small, frequent meals
• Avoid foods with offensive odors
• When nauseated do not drink citrus juice, milk,
  coffee, or tea

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Nutrition-Related Concerns

• Nausea hormonal changes appear to be
  responsible for a womans sensitivities to the
  appearance, smell, or taste of foods
• Suggestions
• On waking, arise slowly
• Eat small, frequent meals
• Avoid foods with offensive odors
• When nauseated do not drink citrus juice, milk,
  coffee, or tea

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Nutrition-Related Concerns

• Constipation as the hormones of pregnancy alter
  muscle tone and the growing fetus crowds the
  intestinal organs
• Suggestions
• Eat foods high in fiber
• Exercise regularly
• Drink plenty of fluids

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Nutrition-Related Concerns

• Heartburn the hormones relax the digestive
  muscles, and the growing fetus puts increased
  pressure on the mothers stomach
• Suggestions
• Relax and eat slowly
• Chew food thoroughly
• Eat small, frequent meals
• Avoid spicy or greasy foods
• Sit up while eating, elevate head when sleeping
• Wait an hour after eating before lying down

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